In Fukuoka prefecture Chikuho district which was once known as one of the nation's leading coal mining districts, Aso Iizuka Hospital is the center hospital with 1,157 beds and 25 departments and about 2,300 outpatients come to the hospital daily. It is well known as a joint-stock company hospital that achieves and keeps good financial management and actively contributes to the local medical community (i.e. establishment of a local emergency center.) Despite much criticism they receive that medical care is not a profit oriented business, their Business Process Re-engineering operation has enabled them to maintain high medical quality with low cost.
Needless to say that their clinical laboratory also has a strong determination towards cost performance and providing quality service. Yet comparing cost with outsourcing being the management approach of Business Process Re-engineering, they had to show the advantage over outsourcing option in terms of cost and quality.
What they chose was to install LAS and LIS and strengthen service contents instead of simply resulting in outsourcing. Economically the system shows drastic effects on cost-cut, decrease in number of devices, integration of emergency departments, and reduction in personnel and occupied space. Moreover, the service improvements made such as speedy testing and 24 hour continuous operation has contributed to the hospital management with its successful operation for the last 2 1/2 years.
This powerful solution has been realized and kept due to their clear vision and strong determination towards laboratory management. We are much honored to have helped the establishment of the system.
We are pleased to introduce the laboratory of Aso Iizuka Hospital and what their next step is.

LAS:A&T/CLINILOG Ver.2+Bayer/MXS		LIS:A&T/CLINILAN Ver.7.5

Sample Reception
Vice Chief Technologist Manako:
There are usually 3 receptionists, 4 to 5 at the most. Centrifuging is performed manually using 3 small centrifuges so no time is wasted on this procedure. The feature of this system is that whole blood for blood testing can be set at the same start stocker as samples for clinical chemistry, urine chemistry and immunology. There is no need of receptionists to be at each section and almost all samples are registered automatically as they arrive.

On/Off-Line Aliquot
Vice Chief Technologist Manako:
The system can minimize the dead volume of sample and tips no matter how many orders one sample has. In this system one unit can aliquot for both on-line use (A: Chemistry serum sample for 502X+200FR+80FR/ B: Urine sample: 502X+80FR+EA06U) and off-line (for Axsym, albumin separation and manual test) with one tip. The throughput is 150-160 samples / hour (1500-2000 tests / hour) with two arms that enable aliquotting two samples at the same time. Since each analyzer uses only daughter samples except for those which analyze whole blood, depositions are separated out from samples by the sensor function of the unit which detects fibrin lump clogging decreasing trouble occurrences.

Immunology Analysis / Off-line Analysis (Axsym)
Vice Chief Technologist Manako:
Two Axsyms by Abbot are used for chemistry tests like infectious disease, tumor marker or hormone. All that needs to be done is the changing and setting of the samples that are automatically pipetted by the aliquot unit. The choice of On- or Off- line can be made on the terminals of system.
[Items]
AFP, CEA, CA19-9, CA125, CA15-3, Ferritin, β2-M, Insulin, PSA, HBsAg, Anti-HBs, HCV, Hbe, Anti-Hbe, HBc, TSH, F-T3, F-T4, T4, T3, LH, FSH, PRL

Immunology and Special Chemistry Analysis (502X)
Vice Chief Technologist Manako:
We make full use of 502X by A&T which can share daughter samples with 200FR and 80FR as well as store samples within the instrument for rerun tests. We are impressed with how this one analyzer functions as a complete TLA system and the developmental ideas that behind it.
[Items]
ASO, RA, IgG, IgM, IgA, C3, C4, HPT, PL, U-TP, M-Alb, Fe, UIBC, NAG, TBA, ZTT, TTT, Fructosamin, CH50

Clinical Chemistry Line and Test (TBA-200FR)
Vice Chief Technologist Manako:
Two 200FRs are running in our laboratory as the main analyzers. The Even Loading Function of the transportation system that compares the loads on each analyzer and sends the next sample to the analyzer with lesser load or the function of passing samples that have no order help maintain high throughput. The rerun process is speedily performed because the same daughter sample is automatically used instead of having another prepared from the parent sample. The combination of the single-multi analyzers and this transportation system covers the common weak points, throughput or backup system, and achieves efficiency and reduction of the amount of sample and reagent used.
[Items]
ALT, AST, γ-GTP, LD, ALP, Amy, BUN, Crea, CHE, TG, CHO, UA, CPK, T-bil, D-bil, Ca, IP, Mg, TP, HDL, CK-MB, P-Amy, Glu, Na, K, Cl, NH3

Clinical Chemistry Line and Test (TBA-80FR)
Vice Chief Technologist Manako:
The 80FR is used as a backup instrument. It has the same throughput as 200FR which means it has a high throughput in its performance as a backup system in operating reruns for 200FR and for special chemistry items (concentration of medicine etc.) and urine for 502X.
[Items]
ALT, AST, γ-GTP, LD, ALP, Amy, BUN, Crea, CHE, TG, CHO, UA, CPK, T-bil, D-bil, Ca, IP, Mg, TP, HDL, CK-MB, Glu, U-TP, U-BUN, U-Crea, SV, DIGO, PB, TEO, CBZ, DPH

Clinical Chemistry Line and HbA1c Test (HLC-723GHbV)
Vice Chief Technologist Manako:
The HLC-723 by Tosoh and 200FR are installed in the transportation line for HbA1c test and glucose test respectively.
[Items] HbA1c

Clinical Chemistry Line and Electrolyte Test (EA06U)
Vice Chief Technologist Manako:
The basic analyzer for electrolyte testing is 200FR, by which retesting, urine and recalled testing are done.
[Items] Na, K, Cl

Hematology Line (H2+H3+HEG-120NAS)
Vice Chief Technologist Manako:
HEG-120NAS by Omron for making blood smear and H2 / H3 analyzer by Bayer Medical are installed. One technologist handles 500 samples (including blood image and the number of blood cells) per day. The graphic display of H2 / H3 allows other technologists to determine sample coagulation easily. White blood corpuscle classification by peroxidase activation and loblation and the separation of abnormal shaped cells and the abnormal cells on the graphic pattern helps blood disease classification.
[Items] Blood cell counting, Blood smears making

Qualitative Urinalysis and Urine Sedimentation
Vice Chief Technologist Manako:
The Clinitek Atlas by Bayer Medical for qualitative analysis and the UF-100 by Sysmex for sedimentation are used as off-line. A part of sedimentation test is done by visual observation.

Chief Technologist Yoshida:
When striving for efficiency in the laboratory, it is important to 1) Construct a flexible system and 2) Utilize it to its full capacity. After installation, it is necessary for the staff to change from sectionalism to having a flexible improvement conscious mind that is not captured by the conventional framework. In addition, in order to see effects of the installed system, active cross-section training is essential.
We have many other things we can do in terms of cost and service. For instance, I suppose we need to be actively involved with other departments. We should be aware that the central laboratory is positioned at the center of the hospital and has close relationships with various decisions and improvements made. Suggestions from the laboratory have become more important in attaining goals which can be seen in the circumstance with the critical pass, DRG/PPS, etc. that are becoming more common. Moreover, there are many other things we can do as a member of the hospital team such as training interns or making proposals to doctors as specialists. If we continue to strengthen the important role of the laboratory in the hospital and improve economic efficiency, decisions favoring branch laboratories or FMS will not be made easily. Furthermore, hospitals can take a step forward in other areas, not only in the economic efficiency of laboratory.

Laboratory Automation System from hospital management: From LAS PRIMER
Katsuharu Kakihana (Advisor of Aso Cement Corp.)

Special thanks to Chief Technologist Yoshida and the laboratory staff of Aso Iizuka Hospital.

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